ABILIFY 2MG TABLET (30 BOX) (NDC: 59148000613)
2012 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$88.00 | $254.00 | None | $1,707.81 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $260.00 | None | $1,708.87 |
Browse Plan Formulary |
Anthem Medicare Preferred Core (PPO)
|
$0.00 |
$60 |
to be determined |
2 |
Tier 2 |
$43.00 | $107.50 | Q:30 /30Days | $1,787.34 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $220.00 | S Q:90 /90Days | $1,708.94 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (PPO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,707.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Gold Rx (Regional PPO SNP)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,708.74 |
Browse Plan Formulary |
Coventry Total Care (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $240.00 | Q:30 /30Days | $1,723.92 |
Browse Plan Formulary |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $102.00 | None | $1,764.00 |
Browse Plan Formulary |
Gold Advantage Option 1 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $240.00 | Q:30 /30Days | $1,722.73 |
Browse Plan Formulary |
Gold Advantage Option II (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $240.00 | Q:30 /30Days | $1,723.30 |
Browse Plan Formulary |
Humana Gold Plus H2649-023 (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:30 /30Days | $1,727.06 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Universal Hassle-Free (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $220.00 | S Q:90 /90Days | $1,708.89 |
Browse Plan Formulary |
WellCare Value (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $172.50 | P Q:31 /31Days | $1,760.01 |
Browse Plan Formulary |
Advantra (PPO)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $240.00 | Q:30 /30Days | $1,723.30 |
Browse Plan Formulary |
Advantra Option 1 (HMO)
|
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $240.00 | Q:30 /30Days | $1,722.35 |
Browse Plan Formulary |
WellCare Access (HMO SNP)
|
$28.10 |
$320 |
to be determined |
3 |
Tier 3 |
$95.00 | $237.50 | P Q:31 /31Days | $1,760.01 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,693.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,697.55 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,696.28 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,702.49 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,696.39 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,689.01 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,705.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,690.16 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,694.80 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,687.08 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,700.68 |
Browse Plan Formulary |
WindsorSterling Emerald Connect Plan (PFFS)
|
$28.50 |
$150 |
to be determined |
4 |
Tier 4 |
$87.00 | $261.00 | None | $1,685.36 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (Regional PPO)
|
$28.90 |
$215 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,708.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Silver Rx (Regional PPO SNP)
|
$31.80 |
$150 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,708.74 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (Regional PPO SNP)
|
$31.90 |
$240 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,708.74 |
Browse Plan Formulary |
Care Improvement Plus Dual Advantage (PPO SNP)
|
$32.10 |
$155 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,707.16 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (PPO SNP)
|
$32.10 |
$205 |
to be determined |
2 |
Tier 2 |
$45.00 | $112.50 | None | $1,707.16 |
Browse Plan Formulary |
Humana Gold Choice H8145-125 (PFFS)
|
$33.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:30 /30Days | $1,719.07 |
Browse Plan Formulary |
HumanaChoice R5826-010 (Regional PPO)
|
$35.20 |
$320 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:30 /30Days | $1,721.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Medicare Advantage (PPO)
|
$38.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,707.16 |
Browse Plan Formulary |
HumanaChoice H1716-020 (PPO)
|
$39.00 |
$320 |
to be determined |
4 |
Tier 4 |
30% | 30% | Q:30 /30Days | $1,720.57 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$42.00 |
$0 |
to be determined |
4 |
Tier 4 |
$88.00 | $254.00 | None | $1,708.02 |
Browse Plan Formulary |
Essence Advantage Plus (HMO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$29.00 | $87.00 | None | $1,764.00 |
Browse Plan Formulary |
WindsorSterling Gold Plus Plan (PPO)
|
$50.00 |
$0 |
to be determined |
4 |
Tier 4 |
$90.00 | $270.00 | None | $1,700.18 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,687.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,700.68 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,696.30 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,689.01 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,693.22 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,697.55 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,696.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,694.80 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,702.49 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,696.39 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,685.36 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,705.78 |
Browse Plan Formulary |
WindsorSterling Gold Connect Plan (PFFS)
|
$59.00 |
$50 |
to be determined |
4 |
Tier 4 |
$84.00 | $252.00 | None | $1,690.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H1716-006 (PPO)
|
$73.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:30 /30Days | $1,726.34 |
Browse Plan Formulary |
Advantra Option 2 (HMO-POS)
|
$88.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $240.00 | Q:30 /30Days | $1,722.35 |
Browse Plan Formulary |
HumanaChoice H1716-019 (PPO)
|
$122.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | Q:30 /30Days | $1,730.75 |
Browse Plan Formulary |